FORM 1023-EZ for PIEDMONT ANIMAL VETERINARY CLINIC INC

Field Data
EIN 85-4116528
Case Number EO-2021063-000788
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PIEDMONT ANIMAL VETERINARY CLINIC INC
Organization’s Mailing Address 228 EAST WATERLYNN RD
City MOORESVILLE
State NC
ZIP 28117
Accounting period End 12
Primary contact name JASON BENGE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JASON BENGE
PRESIDENT
228 EAST WATERLYNN RD
MOORESVILLE NC 28117

Officer/Director/Trustee Two

CHARLOTTE WHITE
TREASURE
228 EAST WATERLYNN RD
MOORESVILLE NC 28117

Officer/Director/Trustee Three

CHRISTIN BENGE
VICE PRESIDENT
228 EAST WATERLYNN RD
MOORESVILLE NC 28117

Officer/Director/Trustee Four

DONALD GULLETT
DEVELOPMENT DIRECTOR
228 EAST WATERLYNN RD
MOORESVILLE NC 28117

Officer/Director/Trustee Five

LORI ROOT
SECRETARY
228 EAST WATERLYNN RD
MOORESVILLE NC 28117

Organization’s website Www.piedmontanimalvet.com
Organization’s email Info@piedmontanimalvet.com
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/30/2020
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D40 - Veterinary Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JASON BENGE
Signature Title PRESIDENT
Signature Date 12/30/2020

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